The aims of this proposed study is the examination of program implementation of two randomized trials of prenatal and early childhood home visitation for first-time families. Specifically, the effects of a disrupted relationship between home visitor and parent on program outcomes of caregiving, parent attitudes, parent-child interaction, and child emotional and behavioral functioning at age two years will be explored in order to further understand the importance of the treatment alliance in preventative service delivery. In the two trials, home visitors (nurses in one trial, paraprofessionals in the other trial) provide information and support to first time parents from pregnancy until the child's second birthday, in order to promote healthy pregnancy and birth, child health and development, and mother's own life course development. These families (n = 228 and 246, for nurse and paraprofessional trials, respectively) are compared to families who receive periodic developmental screenings, but do not receive home visiting services (n = 515 and 254 for nurse and paraprofessional program, respectively). Disruptions in the therapeutic alliance occurs for parents when home visitors leave the program and are replaced (approximately 30% of treatment group participants in each trial). Participants with disrupted relationships will be identified through the home visitor record-keeping system. This will include information on the timing and number of the disruptions. It is hypothesized that mothers in a continuous relationship with one home visitor will show more positive program outcomes compared to mothers in disrupted relationships with multiple home visitors, who in turn will show more positive outcomes than mothers in the comparison groups who received no home visitation services at all. It is further hypothesized that having the disruption in the middle of the program will be more detrimental than a disruption occurring either at the beginning or the end of the intervention period, and that having multiple disruptions will he more detrimental than a single disruption. Effects of program implementation and home visitor quality will also be examined in relationship to alliance disruption.